Dr. Berg's Foot Facts

Posts for tag: achilles tendonitis

Women running

As a runner you know the importance of keeping your feet in top condition. You may be well aware of the most common cause of runner's foot pain, namely heel pain or plantar fasciitis. But another condition nearly as prevalent as heel pain in runners is Achilles tendon pain.

And this shouldn't be surprising. After all the term "Achilles heel" comes from the Greek tragedy, the Illiad. In this saga, Achilles leads the Greeks against the Trojans. A powerful warrior his only weakness is his Achilles. For today's runner this is also true. An Achilles rupture or tear can be a season ending event.

While an Achilles rupture can change the outcome of a game or race, it's by no means the most common form of Achilles tendon pain. Achilles tendonitis and it's cousin Achilles tendonosis are much more common.

What is the Achilles tendon?

The Achilles is the largest and strongest tendon in the body. It can withstand forces of up to 1000 pounds or more. It's located where the calf muscle joins the heel bone. The Achilles makes it possible for us to push off while we run, jump, or walk. Without it we would be incapable of movement. That's why when our Achilles tendon becomes inflamed or sustains an injury treatment is imperative.

Achilles Tendonitis

Achilles tendonitis is an inflammation of the Achilles tendon. It results from micro-tears that develop as a result of too heavy or sudden pressure on the tendon. These can occur as a result of running hills, rapidly increasing training time and distance, and sprinting.

Other risk factors

Other risk factors for Achilles tendonitis are:

  • Sex (men are more prone to it)
  • Increased age
  • Over pronation resulting from flat or low arches
  • Tight calf muscles
  • Wearing unsupportive or worn out running shoes
  • Medical conditions such as psoriasis and high blood pressure
  • Taking antibiotics called fluoroquinolones.

Two types of Achilles tendonitis

There are two types of Achilles tendonitis based on where the inflammation is located, insertional and non-insertional.

Insertional

Insertional Achilles tendonitis occurs in the lower portion of the heel where the tendon inserts into the heel bone. This type of tendonitis tends to develop with years of overuse and is most commonly seen in marathoners and sprinters.

Non-insertional

Non-insertional Achilles tendonitis occurs in the middle portion of the tendon and is more common in younger athletes.

Sign and Symptoms

  • Mild pain after running that gradually worsens.
  • Pain occurs most often after periods of rest and with first steps out of bed in the morning.
  • A dull or sharp pain along back of tendon.
  • Tenderness or sometimes intense pain can be experienced when the sides of the tendon are squeezed.

Treatment

If you're experiencing any of the signs and symptoms of Achilles tendon pain it's important to stop running. Running through your pain will make the condition worse. Rest and sometimes immobilization in a walking boot are necessary to recover from Achilles tendonitis.

In addition, treatment at home or at your podiatry office often includes the following:

Reduce the inflammation

To assist in your recovery it's important to reduce the inflammation.

  • Use ice 20 minutes out of every hour.
  • Take nonsteroidal anti-inflammatory medication. Note: Consult your physician before taking any medication.
     
  • Receive MLS laser therapy for pain relief and reduction of inflammation

Improve your foot biomechanics.

  • Orthotics can help support the muscle and relieve stress on the tendon. Over-the-counter shoe inserts or custom orthotics will both work depending on your foot type and the length and severity of the problem.

Stretch your calf muscles

Adequately stretching tight calf muscles is needed in the treatment and prevention of Achilles tendonitis. One of the best ways to do this is by using an Achilles splint 1-2 times/day for 20-30 minutes while watching TV or reading a book. Please watch this video on How to Use An Achilles Splint for Stretching Calf Muscles. Sports medicine physicians and others also recommend using a foam roller as an adjunct to stretching.

Physical therapy

We recommend physical therapy for:

  • exercises to lengthen the Achilles tendon
  • strengthen the Achilles tendon
  • gait training

Surgery

Surgery may be needed if the tendon does not recover using more conservative approaches.

Prevention

It's far better to prevent Achilles tendonitis than to heal from it.

Achilles Tendonosis

Achilles tendonosis in runners is a degeneration of the collagen protein that forms the tendon. It's a response to chronic overuse without adequate time to heal and rest. When the tendon is damaged in this way, healing is haphazard and abnormal, resulting in pain when put under tension, stressed, or touched. This new tendon can be weaker, prone to re-injury and rupture if not adequately rehabilitated. The tendon will show up thicker on MRI.

Tendonitis can progress to tendonosis when treatment of the former condition has been insufficient. When the disorder progresses to degeneration, it can become enlarged and nodules can develop in the area where the tissue is damaged.

Signs and Symptoms

Runners with Achilles tendonosis will experience pain, tenderness, and stiffness without inflammation (swelling and redness) seen in Achilles tendonitis.

  • Tightness and loss of flexibility in the ankle.
  • Pain particularly after rest and upon wakening in the morning.
  • A nodule on the back of the heel
  • A jellylike consistency internally making the tendon soft and weak

Treatment and Prevention

Treatment and prevention are similar to those employed for Achilles tendonitis with special emphasis on curtailing all activities that put stress on the tendon. Immobilization will be required to ensure the tendon gets adequate healing time. Ice may be of limited value since there is typically no inflammation in this condition. MLS laser therapy has been shown to work well in healing old injuries by bringing more blood floor to the site. It could be of important value in healing Achilles tendonosis.

Achilles Tendon Rupture

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Sudden accelerations during running or a trip or fall can overstretch the tendon and cause a tear.

Achilles tendon ruptures are most often seen in "weekend warriors" – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.

Signs and Symptoms

While sometimes there are no signs and symptoms of Achilles tendon rupture the most common ones are:

  • Feeling of being kicked or stabbed in the calf or ankle
  • Popping or snapping sensation
  • Swelling in the back of the leg between the heel and calf
  • Difficulty walking and rising up on the toes

Risk Factors

Men are at greater risk for Achilles tendon rupture due to their lack of flexibility compared to women. Runners with a previous history of Achilles tendonosis are also at greater risk.

Treatment

Most often Achilles tendon ruptures require surgery since the chance of re-rupture is great for those still planning to continue with their running career. For those who plan a more sedentary lifestyle or concerns about nerve damage or infection should choose a more conservative treatment route similar to those used to treat the other two Achilles tendon conditions.

Prevention

In addition to following all the previous recommendations stated earlier, runners who've a history of Achilles tendonosis should take great care to moderate their level of activity and watch out for irregularities in their running surface.

Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about heel pain in runners download our eBook, "The Complete Guide to Stopping Heel Pain in Runners".

For chronic heel pain, download our eBook, "Stop Living With Stubborn Heel Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.

 

young woman runnerAs a runner, you know already know the benefits of your favorite sport. Better sleep, weight control, more energy, chronic disease prevention--just to name a few.

You've probably had some injuries and want to do everything you can to prevent another one. As a runner with flat feet, keeping your feet in tip top shape can be a bit challenging--but it can be done.

How Flat Feet Affect Runners

Runners with flat feet are over-pronators--meaning their feet roll excessively inward toward the arch when they walk or run. When this happens pain and discomfort can occur in the feet, lower legs, low back, and hips. In the feet this usually means plantar fasciitis (pain in the bottom of the heel or arch) or Achilles tendonitis (pain in the back of the heel).

neutral, flat, and high arched foot printsIf you've experienced problems in any of these areas of your body as a result of running, there's a good chance you have flat feet and are over-pronating. Not sure if you have flat feet? Find out by doing this test. Wet the sole of your foot. Step onto a blank piece of paper or a shopping bag. Step off the paper or shopping bag to examine the shape of your footprint and compare it to the photo on the right.

While over-pronation is a key reason runners with flat feet are more prone to foot pain, another factor--equinus or tight calf muscles--also plays a major role in the development of heel pain and plantar fasciitis.

That's why prevention of the two most common foot problems for runners with flat feet requires both correction of foot mechanics and treatment of tight calf muscles.

Correcting Your Foot Mechanics

While some runners can get away with correcting their flat feet with over-the-counter inserts such as Powersteps or Superfeet, the vast majority will need custom orthotics. Custom orthotics are designed for your feet only and provide the best correction for flat feet.

Stretching Out Tight Calf Muscles

Most runners stretch right before they run. While wall or tree stretches (if you run outside) may seem adequate, stretching for a few minutes will have little impact on very tight calf muscles. Instead, Dr.Rion Berg of the Foot and Ankle Center of Lake City recommends using an splint while reading or watching TV for 20-30 minutes for his patients with tight calf muscles.

Keeping Your Feet in Top Shape

It's also important to keep your plantar fascia or heel cord stretched and your feet strong.

Tennis ball massage
Tennis balls are great for keeping the bottom of your feet stretched out. While seated, use a tennis ball to massage all areas of your feet with special emphasis on your plantar fascia. Massage each foot for 2-3 minutes.

Towel curls
Towel curls can help strengthen your feet. While seated and with your feet on a towel, scrunch up the towel with your foot while your heel stays planted. Repeat 15-20 times with each foot for 2-3 sets.

Maintain A Healthy Weight

Running with a few extra pounds translates to more stress on your feet; seven extra pounds of pressure for every extra pound of weight. So maintaining a healthy weight will reduce the pressure on your feet and reduce your chance for foot pain.

Built Up Your Running Slowly

Just starting a running program with flat feet? Increase your training schedule by no more than 10-20% per week to prevent injury.

Best Training Terrain

Stick to training on flat ground. Running hills can increase your over-pronation putting more stress on your feet and plantar fascia. In addition, hill running and stair climbing put a lot of strain on the Achilles leading to Achilles tendonitis. Finally, softer surfaces are better than hard ones. A running track is a good option.

Buy Running Shoes for Flat Feet

Your shoes are your best defense against foot pain. Old, worn-out shoes will not adequately support your feet. Likewise running shoes that aren't designed for your foot type and the kind of running you do won't either. Be sure to go to a shoe store that specializes in running like Super Jock N Jill, Brooks, or REI in the Seattle area. Their employees are trained to help you find the shoe that will best meet your needs. In addition, check out my blog, "How to Buy the Best Running Shoes".

Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about heel pain in runners download our eBook, "The Complete Guide to Stopping Heel Pain in Runners".

For chronic heel pain, download our eBook, "Stop Living With Stubborn Heel Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.

 

 

As summer approaches we'd all like to make sure our feet will take us where we want to go and allow us to fully participate in the sports activities we love. Unfortunately some of us are more prone to developing certain types of foot problems, such as Achilles tendonitis.

What is Achilles tendonitis?

The Achilles tendon located in the back of your ankle is the largest and strongest tendons in the body; it can withstand up to 1,000 pounds of force. When this structure, also known as the heel cord, becomes inflamed Achilles tendonitis develops. If you ignore this pain, it can rupture which will require surgical intervention.

What Are the Risk Factors?

Many factors can lead to Achilles tendonitis:

  • Faulty foot structure such as flat feet

  • Equinus or tight calf muscles

  • Overuse mainly through physical activity

What You Can Do To Prevent Achilles Tendonitis

Fortunately there's a lot you can do to prevent Achilles tendonitis. Some of these fixes are mechanical in nature. For example, if you have flat feet getting fit with custom orthotics will prevent your feet from pronating, which can cause undo pulling on your Achilles. In addition, if you have tight calf muscles you can use special stretching techniques to alleviate this problem.

All the other prevention techniques are related to how you exercise.

Purchase Shoes Made for Your Sport
Buying supportive shoes is essential and wearing shoes that are designed specifically for your sport is a must. Be sure to go to a store where employees are trained to fit shoes to different types of feet. Shoes should also be replaced every 500 miles.

Vary Your Terrain
In Seattle you have lots of opportunity to get a great workout on hills. But don't overdo it or you'll increase you Achilles tendonitis risk. Vary the type of terrain you run or hike on from day to day or even on the same day. Do hills one day and run Greenlake another day. Mix it up.

Don't Forget to Warm-up
Both new and veteran athletes should warm up before working out. Dynamic warm-ups for runners are a great way to go.

Gradually Increase Your Training Time
You might want to get ready to run that race with your friends and end up overdoing it. Unfortunately your Achilles can't adapt that quickly to a huge increase in your training regimen. Do your Achilles a favor--increase training time by no more than 10% a week to avoid injury.

Change Up Your Exercise Routine
You might love to run but it's great to take a break by swimming or cycling to reduce strain on your Achilles.

How to Treat Achilles Tendonitis

At home

  • Pay attention to your body. If you're feeling pain in the back of your heel, back off from your exercise

  • Icing the back of your heel will help reduce inflammation

  • Toss your worn out shoes

  • Taking nonsteroidal anti-inflammatory medication for a period of time. Note: Please consult your physician before taking any medication.
     

At the podiatrist's office

  • Immobilizing the foot can reduce imflammation and pain; this is most commonly done with a walking boot
  • Getting fit with custom orthotics - see above.
  • Receiving MLS laser therapy for pain relief and reduction of inflammation
  • Getting referred to physical therapy for strengthening exercises, soft-tissue massage/mobilization, and gait and running education.

Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about heel pain in runners download our eBook, "The Complete Guide to Stopping Heel Pain in Runners".

For chronic heel pain, download our eBook, "Stop Living With Stubborn Heel Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.

You're a runner and you've had to deal with foot and knee injuries. A new study published in the American Journal of Sports Medicine provides more evidence running lightly can reduce injuries.

The effects of running lightly have been studied before. In 2016, I wrote a blog about a study of light footed women runners done at Harvard. In this study women who ran more lightly never got injured.

The new study measured the landing impact of 320 novice runners.Half the runners were told to run softer while the other half were not. After 12 months, those who learned to run softer had a 62 percent decrease in injuries than the runners who made no change.

What Does It Take to Run Softer

  • Think about running more softly and quietly when you're running; another study showed that runners who were told to run softly and quietly could reduce their foot impact.
  • Land on your mid or forefoot instead of the heel (Video on low impact running).
  • Use quick foot strikes and a shorter stride.
  • Try Chi Running which takes some of its principles from Tai Chi. You can also purchase the app of the same name.

In addition to running softer there are many other things you can do to reduce your chances of developing foot injuries such as Achilles tendonitis and plantar fasciitis.

  • Increase your mileage slowly. Most experts recommend only a 10% increase each week.

  • Always stretch before you run. We recommend Dynamic Warm-ups for the best results. Tight calf muscles often play a huge role in developing heel pain and Achilles tendonitis. Here is what we recommend for patients who already have these conditions with tight calf muscles.

  • Make sure your shoes fit properly and aren't worn out.

  • Running can affect your hips, back, knees, and feet. Don't ignore pain. It's a signal that something is amiss.

More information on pain free running:
8 Hacks To Prevent Running Injuries this Summer
4 Lacing Hacks To Reduce Painful Running Problems
5 Tips to Keep Runner's Feet Healthy and Strong

If you're a runner experiencing hip, back, knee or foot pain, call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about heel pain in runners download our eBook, "The Complete Guide to Stopping Heel Pain in Runners".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Google+

By Dr. Rion Berg
May 11, 2018
Category: Heel pain

Just about this time of year my office starts to fill up with patients who decide to take up running to get in shape, lose weight, or challenge themselves by racing. Although I love taking care of people, I'd rather make sure they don't get injured in the first place.

Running is definitely an injury-prone sport. Fortunately there are lots of things you can do to prevent running injuries this summer. Here are 8 sure fire hacks that will greatly reduce your risk of a running injury or foot problem like plantar fasciitis, Achilles tendonitis, or an ingrown toenail.

Start Slowly

If you're new to running or you've run in the past but haven't for a while, it's important to start slowly. Even if you lay off running for a few weeks, research shows the bodies' tolerance diminishes during that short time. Instead of returning to your usual five miles a day, take it easy.

Start off running for 10-15 minutes at a time and increase by 10% a week. That way your chance of a foot injury is far less.

Stop Running If Your Feet Hurt
Although it should go without saying, it always amazes me how many people just assume that pain is a good thing. I think it comes from that saying "no pain, no gain". When it comes to foot pain if you feel pain, you won't gain. You'll only lose and end up with an injury. So stop running when your feet or any part of your body starts to hurt.

Make Sure Your Shoes Fit and Aren't Worn Out

Wear the Right Socks

Although you won't get heel pain or Achilles tendonitis from wearing cotton socks you will get some nasty blisters. Avoid cotton and buy socks made out of synthetic materials that wick away moisture.

Do Proper Stretching

We've all heard that we need to stretch before we run, but most of us don't do it for long enough or correctly. A simple calf stretch done for a minute or less is usually not enough for most people to really make much difference. If you are prone to heel pain or Achilles tendonitis, tight calf muscles are frequently part of the problem. I recommend my patients who already have heel pain or are prone to it use an Achilles splint for 30 minutes a day to stretch their calves.

Dynamic warm-ups are also important to get your body ready for running. Some evidence shows that doing a static stretch right before running can inhibit performance.

Avoid High Heels

Frequent wear of high heels leads to shortened calf muscles. Tight calf muscles are often a big factor in bringing on plantar fasciitis or Achilles tendonitis. If you plan to wear high heels and also run, try to avoid going directly from heels to running.

Change Up Your Exercise

Rather than run every day, go swimming, do yoga, or another aerobic activity. Changing up your exercise will make you less prone to injury. Also, a strong core can help you recover more easily after tripping on a rock or other object in the road.

Eat A Healthy Diet

Staying hydrated and eating a healthy diet are also important for preventing injuries. You're less likely to lose steam and turn an ankle. Also, women who are too thin or are post-menopausal are at greater risk for stress fractures.

If you feel pain while running, call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about heel pain in runners download our eBook, "The Complete Guide to Stopping Heel Pain in Runners".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Google+